Original Title: Inhibiteurs de la pompe à protons : déprescription et modification des habitudes de vie

Authors' objectives: This report constitutes the second phase of the work, the objective of which is to equip front-line health professionals to deprescribe PPIs and to acquaint them with the recommended strategies for lifestyle changes that can provide symptomatic relief of gastroesophageal reflux disease (GERD) and dyspepsia in adults.

Authors' results and conclusions: RESULTS (#1 PPI THERAPY SHOULD BE REEVALUATED IN THOSE WHO HAVE BEEN TAKING IT FOR MORE THAN 8 WEEKS WITH NO INDICATION JUSTIFYING ITS LONG-TERM USE): In the presence of an indication for long-term treatment, deprescription is not recommended, but consideration should be given to reducing the intake to a once-daily dose in those taking a PPI twice daily. If there are persistent symptoms despite optimal adherence to PPI therapy and no condition justifying long-term treatment, the PPI should generally be discontinued because of its ineffectiveness. Consideration could be given to looking for other causes that might explain the symptoms and to conducting an additional investigation. (#2 THE DIFFERENT PPI DEPRESCRIPTION APPROACHES ARE DOSE REDUCTION, ON-DEMAND DOSING, AND COMPLETE DISCONTINUATION): The choice between the different PPI deprescription strategies should be discussed between the person and health professional. Symptoms may reappear transiently when the PPI is discontinued or when the dose is reduced, but these symptoms do no warrant restarting the drug. Certain strategies for relieving these symptoms are proposed, such as using antacids or an H2 receptor antagonist or taking a PPI only as needed, in addition to lifestyle changes. Certain lifestyle changes concerning eating habits, sleep, stress management, physical activity and smoking and alcohol consumption should be discussed with the persons concerned. (#3 A PPI DEPRESCRIPTION FOLLOW-UP SHOULD INCLUDE A SYMPTOM REASSESSMENT AND ADVICE CONCERNING THE OTHER APPROACHES, PHARMACOLOGIAL OR OTHERWISE): A close follow-up (i.e., after 4 to 12 weeks) is recommended after a PPI is despresribed and should ideally be done under the responsibility of the community pharmacist. The objective of the follow-up should be to reassess and record the presence of GERD or dyspepsia symptoms, in particular, their frequency and severity, and the effectiveness of the nonpharmacological measures or other treatments. Returning to the previous effective dose may be considered if the symptoms persist after the discontinuation or dose reduction, if the PPI interferes with the person’s daily activities or if they do not obtain relief with the other approaches, pharmacological or otherwise. If applicable, a follow-up should be done in 4 to 12 weeks with a view to considering a new deprescription attempt. If the treatment is continued, the subsequent follow-up can be done annually. CONCLUSION: The PPI deprescription decision algorithm is based on clinical practice recommendations, which were supplemented with the perspectives of the stakeholders consulted, including those of patients, and contextualized for Québec practice. This tool should help enhance and harmonize the practice and contribute to the effective management of persons in whom deprescribing a PPI is indicated. However, the enhancement and harmonization of the practice will depend on : • The dissemination of the decision algorithm; • The adherence to the changes and the uptake of the recommendations by the health professionals concerned; • The availability of training, when needed; and • The promotion of this tool within the health and social services system

Authors' methods: For this phase, a rapid review of the literature containing information and clinical recommendations concerning PPI desprescription and lifestyle changes for relieving the symptoms of dyspepsia and GERD was carried out on publications found in bibliographic databases and other information sources. The data and contextual elements gathered were analyzed and synthesized with a view to contextualizing the practice in Québec, based mainly on legislative, regulatory and organizational contextual information specific to Québec and on the perspectives of the different stakeholders who were consulted. These perspectives were gathered by means of an advisory committee consisting of health professionals from different specialties and areas of expertise. The perspectives of current and past PPI users regarding the acceptability issues relating to PPI depresciption and to lifestyle changes were gathered by means of one-on-one interviews. Lastly, the overall quality of the work, its acceptability and its applicability were assessed by external reviewers specializing in the field of interest and by future users who did not participate in the project.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/usage-optimal-a-long-terme-des-inhibiteurs-de-la-pompe-a-protons.html

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/Medicaments/Inhibiteur_pompe_protons_Volet_2_GN_INESSS.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)